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Research & Reviews : Journal of Medical Science & Technology

Contents

1. A Rare Variant of Holoprosencephaly: Ethmocephaly with Inferior Proboscis and Amelia Adil Asghar, Vinod Kumar, Monika Srivastava, Aparna Dixit, Mamta Rani, Atif Atiq, Nand Kishore Gupta

2. Assessment of Prognosis in Madhumeha (Diabetes Mellitus) Using Tail Bindu Mutra Pariksha Arora Smita

3. Patients with Migraine: Precipitating and Aggravating Factors, Disease Related Problems, Treatment Seeking Behaviour in a Tertiary Hospital Monaliza, Latika Bajaj, Prabhjot Kaur, Ramandeep Kaur, Ramandeep Kaur, Renuka, Sakshi, Dheeraj Khurana

4. Automatic Gain Control Amplifier for Analog Front End in Biomedical Applications Bhumit Rojivadia, Krunal Tank, Dipesh Panchal

5. Effect of Kineso Taping with Exercise versus Ultrasound with Exercise on Pain Relief in Acute Carpal Tunnel Syndrome Jency Sudha Deva Arul, Sharminiy Muniandy, Rishikesavan Raghupathy, Sundaresan A. N, Elanchezhian Chinavan, Yu Chye Wah

Research & Reviews: Journal of Medical Science and Technology ISSN: 2319-3417(online), ISSN: 2349-1272(print) Volume 5, Issue 3 www.stmjournals.com

A Rare Variant of Holoprosencephaly: Ethmocephaly with Inferior Proboscis and Amelia Adil Asghar*, Vinod Kumar, Monika Srivastava, Aparna Dixit, Mamta Rani, Atif Atiq, Nand Kishore Gupta Department of Anatomy, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India

Abstract Ethmocephaly is a rare phenotypic variant of holoprosencephaly, characterized by the failure of embryonic prosencephalon to properly divide the orbits of the eye into two cavities with grossly incomplete morphogenesis of fore brain. The severity has a marked variability and ranges from hypotelorism to cyclopia with craniofacial dysmorphism, such as microcephaly with a single central incisor. Reports of this anomaly are few and because of the rarity even among Holoprosencephaly. We report a case of ethmocephay with inferior probocis from 32year-old lady G2P1L1 with previous history of normal vaginal delivery who presented to us 40 weeks of pregnancy with no fetal movements. She delivered stillbirth: a female fetus with multiple defects and diagnosed as a case of holoprosencephaly with ethmocephaly. Normally the ethamocephaly with superior probocis is usual presentation. But this stillborn fetus cyclop has inferior proboscis, ill-developed face, amelia and foot abnormalities. This case is presented because of atypical presentation of ethmocephaly like, amelia, absent of both ears, mouth opening which are not mentioned in any previous literatures. Keywords: Ethmocephaly, holoprosencephaly, inferior proboscis, amelia

INTRODUCTION Abnormalities of the brain one of the significant cause of childhood mortality and morbidity and associated financial and psychosocial implications for family. Holoprosencephaly consists of a group of disorders arising from failure of normal forebrain divided into two cerebral hemispheres. It has incidence of approximately 0.6 per 10000 live births [1]. It includes a broad range of severity varies from cyclopia, ethmocephaly, and cebocephaly which is the most severe facial malformation to median cleft lip or absent of central incisor teeth least one [2]. As the disturbance of genetic, metabolic or environmental insult in utero leading to severe holoprosencephaly and midline disturbances --cyclopia or ethmocephaly occurs in early life, are inevitable and direct consequences are associated with spectrum of neurological and facial anomalies. Ethmocephaly is least common type having narrow set eye, proboscis, low set ear and may be premaxillary agenesis [3].

Fig. 1: Still Birth Female Fetus with Holoprosencephaly with Amelia: Variant of Ethmocephaly.

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Research & Reviews: Journal of Medical Science and Technology ISSN: 2319-3417(online), ISSN: 2349-1272(print) Volume 5, Issue 3 www.stmjournals.com

Assessment of Prognosis in Madhumeha (Diabetes Mellitus) Using Tail Bindu Mutra Pariksha Arora Smita* Department of Kriya Sharir (Physiology), Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Najafgarh, Government of NCT of Delhi, New Delhi, India Abstract The science of Ayurveda is supposed to be based upon observations and experience based medical science. The physiological aspects of Ayurvedic concepts are equally important to pathological and clinical Ayurveda. In Ayurvedic texts various methods of examination of patient (Rogi Pariksha) as well as disease (Roga Pariksha) has been described separately. Tail Bindu Pariksha as described in yoga ratnakar is one such method of urine examination. The Tail Bindu Mutra Pariksha using Sesame oil is a unique technique for urine examination, which is diagnostic as well as prognostic in nature and provides information about the disease and patient too. In the present era of life style disorders, Diabetes mellitus stands at top worldwide. In this paper, the practical aspects of this old technique “Tail Bindu Mutra Pariksha” have been described in the patients of Diabetes mellitus (Madhumeha) particularly. The Test was carried out in 10 patients of Madhumeha (Diabeties mellitus) to look for the prognosis of disease. Various aspects of Mutra Pariksha, such as spreading time, shape and direction of Tail bindu have been considered in “Tila Tail Pariksha”. The time of the urine sample collection has been kept same in all the patients. The observations have been made on the basis of proforma prepared and the characteristics appeared in the patient’s urine sample. The present research yielded the conclusion that, Tila Tail Mutra Pariksha not only helps in assessing the diagnostic features of a diabetic patient but also indicates towards the prognosis of the disease for that particular person. Keywords: Tail bindu, Tail bindu Mutra Pariksha, Vataja prameha, Madhumeha, Diabetes mellitus

INTRODUCTION There are various methods mentioned in Ayurveda for examination of disease and patient. This examination gives the knowledge about disease, dosha involved and prognosis of disease. In Ayurveda, various modes of examination of disease and patient have been mentioned viz. Trividha Pariksha (3 types examination), Yadavidha Pariksha (6 types examination), Ashtavidha Pariksha (8 types examination), and Dashavidha Pariksha (10 types examination), etc. Scholar Yogratnaka has explained about Ashtavidha Pariksha (i.e. 8 diagnostic methods) to assess the patient’s condition and prognosis for the disease, viz. Naadi (Pulse), Mutra (Urine), Mala (Faeces/Stool), Jihva (Tongue), Shabda (Sound/Crepitus/Fremitus etc.), Sparsha (Touch), Driga (Eyes) and Akriti (Physical) [1].

The aim and objective of the present study is to authenticate the diagnosis and prognosis of a pramehi (diabetic patient) by Tail Bindu Mutra Pariksha. One of Ashtavidha pariksha (8 types of examination) is Mutra Pariksha (Urine examination) playing a major role in diagnosis and prognosis of disease. In present study, clinically it was observed in patients of Madhumeha (diabetes mellitus), a type of Prameha, so as to see the aspects of Tail bindu pariksha of Mutra. As projected by WHO, diabetes mellitus has gained gigantic disgrace in present time being the largest silent killer all over the world. The number of diabetic patients is also increasing in India year by years because of disturbed life style. Early diagnosis of Diabetes Mellitus Type II is difficult, however, the preventive strategy of Ayurveda can help prevent this disease or keep it under control if already suffering from

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Research & Reviews: Journal of Medical Science and Technology ISSN: 2319-3417(online), ISSN: 2349-1272(print) Volume 5, Issue 3 www.stmjournals.com

Patients with Migraine: Precipitating and Aggravating Factors, Disease Related Problems, Treatment Seeking Behaviour in a Tertiary Hospital Monaliza1, Latika Bajaj1,*, Prabhjot Kaur1, Ramandeep Kaur1, Ramandeep Kaur1, Renuka1, Sakshi1, Dheeraj Khurana2 1

Department of Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India 2 Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Abstract Background: Migraine is highly prevalent, disabling and benign neurological disorder. It is characterized by unilateral throbbing pain, which is moderate to severe in intensity and associated with certain symptoms that may or may not be preceded by focal symptoms called an aura. The current study was conducted with the objectives to assess precipitating and aggravating factors, disease related problems and treatment seeking behaviour among patients with migraine attending neurology OPD in a tertiary hospital. Materials and Method: The study was conducted by employing descriptive approach on 105 patients with migraine visiting neurology OPD, PGIMER, Chandigarh. The data was collected through structured interview and self-reports of the subjects. The data was analyzed using SPSS (version 16.0). Results: The mean age of the study subjects was 35.16±1.06 years with a range of 17– 62 years. Majority of them were females who reported noise and stress as the most common aggravating and precipitating factors with irritability, fatigue and light headedness as the most common symptoms associated with migraine attacks. All the study subjects were taking prescribed medications and >95% reported that the medications relieved their symptoms. Conclusion: Migraine is debilitating and affects sufferer’s quality of life. Management of aggravating and precipitating factors is an important aspect of migraine management on which extensive patient education is required. Keywords: Aggravating factors, disease related problems, migraine, precipitating factors, treatment seeking behaviour

INTRODUCTION Migraine is a benign and recurring syndrome of headache associated with other symptoms of neurologic dysfunction. It is the second most common cause of headache that affects approximately 15% of women and 6% of men [1]. Several studies documented the negative influence of headache disorders on the quality of life and reduced productivity due to absenteeism and reduced performance while at work [2–4]. In the World Health Report (2002), Migraine is ranked 20th among disorders causing years lived with a disability (YLDS) at a global level. Migraine can often be recognized by its activators referred to triggers

including glare, sound, hunger, excess stress etc. [1]. It is often made worse by certain activities or conditions e.g. ascending stairs, lifting, coughing etc. The patients with migraine usually feature sensitivity to light, sound or movement accompanied with nausea, vomiting. Followed by visual disturbance (e.g. photopsia), light headedness, scalp tenderness, paresthesia, diarrhea and altered consciousness. Different categories of medicines are available for the treatment of migraine. Many nonpharmacological approaches are also combined to reduce the frequency and impact like a regulated lifestyle including healthy diet, regular exercise, regular sleep patterns,

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Research & Reviews: Journal of Medical Science and Technology ISSN: 2319-3417(online), ISSN: 2349-1272(print) Volume 5, Issue 3 www.stmjournals.com

Automatic Gain Control Amplifier for Analog Front End in Biomedical Applications Bhumit Rojivadia, Krunal Tank, Dipesh Panchal* Department of Electronics and Communication Engineering, Nirma University, Ahmedabad, Gujarat, India Abstract This paper presents the design review of feed-forward automatic gain control (AGC) amplifier to be used in analog front end of biomedical applications such as hearing aid. To make system low-power, the design of each block is optimized and all elements are realized using MOS. The whole design is simulated in LT spice IV using 0.18 µm CMOS technology and the results are presented. Keywords: Automatic gain control (AGC), biomedical signal acquisition, analog circuit simulation, biomedical circuits and systems

INTRODUCTION In biomedical applications such as in hearing aid or bionic ear, the main constraints are low power and low noise. For comfortable hearing in noisy environments, the gain of output available to patient must be variable as per the requirement and it must be automatic. An automatic gain control (AGC) amplifier can be realized through feed-forward and feed-back method. The feed-back method employs a closed loop system wherein the output is sampled through peak-detector and the gain is controlled (Figure 1). The feed-forward AGC senses the input level and as per the requirement forwards the change in gain required.

Fig. 1: Block Diagram of Feed-Forward AGC [1].

as the initial stage which checks the input level and provides the control for variable gain is presented. Two-Stage Operational Amplifier Design OP-amp is the basic building block of any analog design (Figure 2). Configuring op-amp into different ways provides various ways of signal processing. The standard two-stage opamp is designed for 0.18 µm CMOS technology. Op-amp is basically made up of four different stages: 1) Input stage consisting of dual input dual output differential amplifier, 2) Dual input single output, 3) Level shifter or dc compensation, 4) output stage consisting of power amplifier. But looking into practical aspects of design, it basically requires differential amplifier, biasing stage, DC compensation and output stage. Differential amplifier provides the required gain for the opamp. In biasing stage, current mirror is used in order to maintain the current in all the branches of differential amplifier. For DC compensation, capacitor is introduced between differential amplifier and output stage. Output stage is used to provide the low output impedance and power amplification. Op-amp design consist of 2 PMOS and 6 NMOS. The design is based on the one provided by Zou et al. [2].

In this paper, the design review is presented by starting with two-stage operational-amplifier design which is used to realize the variable gain amplifier (VGA). The design of VGA is presented with its gain versus frequency response. Finally, the system with comparator

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Research & Reviews: Journal of Medical Science and Technology ISSN: 2319-3417(online), ISSN: 2349-1272(print) Volume 5, Issue 3 www.stmjournals.com

Effect of Kineso Taping with Exercise versus Ultrasound with Exercise on Pain Relief in Acute Carpal Tunnel Syndrome Jency Sudha Deva Arul*, Sharminiy Muniandy, Rishikesavan Raghupathy, Sundaresan A. N, Elanchezhian Chinavan, Yu Chye Wah School of Physiotherapy, Faculty of Allied Health Professions, Asian Institute of Medical Science and Technology, Semeling, Bedong, Kedah, Malaysia

Abstract Carpal tunnel syndrome is the most frequent compression neuropathy with an estimated prevalence in the general population of 3.7–5.8%. It may be up to three times more common in women than men, with the prevalence highest in the 40–55 year old age group. Global country Malaysia has higher prevalence of CTS among nurses, dentists and other occupations with more wrist flexion movement in Malaysia. Higher prevalence was shown in respondents who were more than 30 years old (25.0%) compared to age below 30 years (3.2%). Carpal tunnel syndrome is the most common peripheral entrapment neuropathy with prevalence rates 21.5% (overall), 32.5% (technicians) and 12% (attenders). The rate increased with increasing age and years of employment and it affects women more than men. The prevalence of CTS was found to be 13.1% among computer professionals. Subjects with over 8 years of computer work, over 12 h of work per day and system administrators were at a higher risk for CTS. Flexed or extended hand position had higher risk for CTS. Quasi experimental comparison study of two different groups was performed. 30 patients with acute carpal tunnel syndrome are included for the study based on simple random sampling. All English, Malay or Tamil speaking patients, 30 to 60 years old who presented with acute carpal tunnel syndrome and met the requirement of inclusion and exclusion criteria were included in the study. The result obtained from this study shows that control group ultrasound with exercise relief pain in the t test result 9.886 and the p-value is 0.000**, which is significant compared to the test group ttest value which is 5.264 and the p value 0.000**. The control group which is ultrasound with exercise improve grip strength of the right hand shows significant result in t-test –2.750 and the p value is 0.016* compared to the test group Kinesio taping t test result, –2.432 and p value is 0.029. Keywords: Carpal tunnel syndrome, visual analogue scale, Boston carpal tunnel syndrome questionnaire, grip strength using handheld dynamometer

INTRODUCTION Carpal tunnel syndrome (CTS) is defined in the ACC distal and upper limb guidelines (2009) as a symptomatic compression neuropathy of the median nerve at the level of the wrist, characterized by decreased function of the nerve at that level. This can result in variable symptoms such as numbness, tingling, hand and arm pain and muscle dysfunction. The carpal tunnel (CT) is found at the base of the palm. It is bounded partly by the eight carpal bones and partly by a tough fibrous roof called the transverse carpal ligament (TCL). The tunnel gives passage to eight digital flexor tendons

(two for each of the medial four fingers); flexor policies longus (FPL) tendon for the thumb; their flexor synovial sheaths; and the median nerve (MN). CT is therefore quite tightly packed and any condition that might increase the volume of the structures inside it can cause compression of the MN. This in turn might lead to ischemia of the nerve which presents as pain and paraesthesia [1]. The carpal tunnel is a narrow passageway in the wrist, which opens into the hand. It is surrounded by the bones of the wrist (underneath) and the transverse carpal

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